0001209191-23-048555.txt : 20230906
0001209191-23-048555.hdr.sgml : 20230906
20230906205516
ACCESSION NUMBER: 0001209191-23-048555
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20230901
FILED AS OF DATE: 20230906
DATE AS OF CHANGE: 20230906
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Eisner Mark
CENTRAL INDEX KEY: 0001834161
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36740
FILM NUMBER: 231240800
MAIL ADDRESS:
STREET 1: C/O FIBROGEN, INC.
STREET 2: 409 ILLINOIS STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94158
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FIBROGEN INC
CENTRAL INDEX KEY: 0000921299
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 409 ILLINOIS STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94158
BUSINESS PHONE: 415-978-1200
MAIL ADDRESS:
STREET 1: 409 ILLINOIS STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94158
4
1
doc4.xml
FORM 4 SUBMISSION
X0508
4
2023-09-01
0
0000921299
FIBROGEN INC
FGEN
0001834161
Eisner Mark
C/O FIBROGEN, INC.
409 ILLINOIS ST.
SAN FRANCISCO
CA
94158
0
1
0
0
EVP, Chief Medical Officer
0
Common Stock
2023-09-01
4
F
0
1085
1.06
D
161777
D
Represents shares withheld by the issuer to satisfy a tax obligation realized by the reporting person upon the vesting of restricted stock units.
/s/ Michael Hom, Attorney-in-fact
2023-09-06
EX-24
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints the following persons from FibroGen, Inc., a Delaware corporation (the
"Company"): Juan Graham, Michael Lowenstein, John Alden, Michael Hom, Cecelia
Monoarfa-Taime, Michelle Simonetti, Tricia Stewart, and Faith Holle, and certain
employees of Cooley LLP, the law firm retained by the Company, specifically Eric
Steiner, Justin Kisner, Nancy Wojtas, Julia Stark, Brett White, and John
McKenna, as the undersigned's true and lawful attorney-in-fact, with full power
and authority as hereinafter described on behalf of and in the name, place and
stead of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including
any amendments thereto) with respect to the securities of the Company, with the
SEC, any national securities exchanges and the Company, as considered necessary
or advisable under Section 16(a) of the Securities Exchange Act of 1934, as
amended (the "Exchange Act") and the rules and regulations promulgated
thereunder, as amended from time to time;
(2) seek or obtain, as the undersigned's representative and on the undersigned's
behalf, information on transactions in the Company's securities from any third
party, including brokers, employee benefit plan administrators and trustees, and
the undersigned hereby authorizes any such person to release any such
information to the undersigned and approves and ratifies any such release of
information; and
(3) perform any and all other acts which in the discretion of such
attorney-in-fact are necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in their discretion on information provided to such
attorney-in-fact without independent verification of such information;
(2) any documents prepared and/or executed by such attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney will be in such form and will
contain such information and disclosure as such attorney-in-fact, in his or her
discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the undersigned's responsibility to comply with the requirement of the Exchange
Act, (ii) any liability of the undersigned for any failure to comply with such
requirements, or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigned's obligations under the Exchange Act,
including without limitation the reporting requirements under Section 16 of the
Exchange Act.
The undersigned hereby gives and grants the foregoing attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the foregoing
matters as fully to all intents and purposes as the undersigned might or could
do if present, hereby ratifying all that such attorney-in-fact of, for and on
behalf of the undersigned, shall lawfully do or cause to be done by virtue of
this Limited Power of Attorney.
This Power of Attorney shall remain in full force and effect until the earlier
to occur of (i) revocation by the undersigned in a signed writing delivered to
such attorney-in-fact, (ii) the undersigned is no longer required to file Forms
3, 4 and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company, or (iii) as to any attorney-in-fact
individually, until such attorney-in-fact shall no longer be employed by the
Company or Cooley LLP, as applicable.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of August 22, 2023.
/s/ Mark Eisner